Laparoscopic Adhesiolysis in Chronic Abdominal Pain: 15-Year Follow-up Study

Review article: diagnostic and therapeutic approach to persistent abdominal pain beyond irritable bowel syndrome

BACKGROUND

Persistent abdominal pain (PAP) poses substantial challenges to patients, physicians and healthcare systems. The possible aetiologies of PAP vary widely across organ systems, which leads to extensive and repetitive diagnostic testing that often fails to provide satisfactory answers. As a result, widely recognised functional disorders of the gut-brain interaction, such as irritable bowel syndrome and functional dyspepsia, are often diagnosed in patients with PAP. However, there are a number of less well-known differential diagnoses that deserve consideration.

AIM

To provide a comprehensive update on causes of PAP that are relatively rare in occurrence.

METHODS

A literature review on the diagnosis and management of some less well-known causes of PAP.

RESULTS

Specific algorithms for the diagnostic work-up of PAP do not exist. Instead, appropriate investigations tailored to patient medical history and physical examination findings should be made on a case-by-case basis. After a definitive diagnosis has been reached, some causes of PAP can be effectively treated using established approaches. Other causes are more complex and may benefit from a multidisciplinary approach involving gastroenterologists, pain specialists, psychologists and physiotherapists. This list is inclusive but not exhaustive of all the rare or less well-known diseases potentially associated with PAP.

CONCLUSIONS

Persistent abdominal pain (PAP) is a challenging condition to diagnose and treat. Many patients undergo repeated diagnostic testing and treatment, including surgery, without achieving symptom relief. Increasing physician awareness of the various causes of PAP, especially of rare diseases that are less well known, may improve patient outcomes.

Facile fabrication of phospholipid-functionalized nanofiber-based barriers with enhanced anti-adhesion efficiency

Electrospun nanofibrous membranes (NFMs) have attracted considerable attention as a potential physical barrier for reducing postoperative adhesion. However, no anti-adhesion barrier can completely prevent adhesion formation. In this study, phospholipid-functionalized NFMs were readily fabricated by one-step electrospinning to obtain nanofiber-based barriers with enhanced wettability and anti-adhesion efficiency. The optimized phospholipid NFMs were shown to have a fiber diameter of 831 nm ± 135 nm that is drastically decreasing, high porosity of 87.6 % ± 1.1 %, and superior hydrophilicity. Moreover, the phospholipid NFMs with excellent cytocompatibility exhibited fibroblasts being significantly reduced (≈ 51 %) after incubation of 3 days compared to that of the NFMs (≈ 96 %), confirming long-lasting anti-adhesion capability against fibroblasts. Meanwhile, less cell adhesion and proliferation of Raw 264.7 macrophages on NFM-10Lec indicated its superior anti-inflammatory effects. Thus, the facile phospholipid-functionalized nanofibers provided a promising strategy for anti-adhesion applications.

Does Laparoscopic Adhesiolysis Reduce the Risk of Small Bowel Obstruction Related Readmissions and Reoperations Compared to Open Adhesiolysis?

Purpose

The present study aimed to assess the safety and efficacy of laparoscopic adhesiolysis in decreasing recurrent episodes of small bowel obstruction (SBO) compared to that of the conventional open procedure.

Methods

Among 373 patients who visited our emergency department from January 2000 to July 2018 due to small bowel obstruction, 67 patients who underwent adhesiolysis were included in this study. Eighteen and 49 patients comprised the open adhesiolysis (OA) and laparoscopic adhesiolysis (LA) groups, respectively. Clinical demographics, computed tomography (CT) findings, laboratory results, and perioperative outcomes were compared. Further, the long-term follow-ups of SBO related re-admissions and re-operations were also compared.

Results

Preoperative baseline data, pain characteristics, laboratory findings, and ileus-related CT findings showed no significant difference between the two groups. LA was related to less blood loss and complications, along with early bowel movement recovery. Similarly, fewer SBO-related re-admissions [OA vs. LA=8 (44.4%) vs. 3 (6.1%), p=0.001] and re-operations [OA vs. LA=3 (16.7%) vs. 1 (2.0%), p=0.025] were observed in LA compared to OA.

Conclusion

LA is a safer and more feasible procedure for SBO treatment compared to OA. This procedure showed a reduction in SBO-related re-admission and re-operation rates.

Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett's test

Background

Chronic abdominal pain is a common clinical problem. However, diagnosing chronic abdominal pain often requires detailed diagnostic evaluations in addition to sufficient history taking and physical examination, owing to its uncertain etiology.

Case presentation

We report a case of a 36-year-old man with chronic abdominal pain originating from postoperative adhesions. Postoperative adhesions are common phenomena, and abdominal surgery can cause severe abdominal pain, the source of which can be difficult to detect. Carnett’s test is useful to detect abdominal wall tenderness and to determine the affected abdominal quadrant. Incorporating its use with a detailed chronological clinical history contributes to the improvement of diagnostic accuracy. In addition to the above-mentioned information, attention to subtle imaging findings may provide greater diagnostic accuracy.

Conclusions

Abdominal pain induced by postoperative adhesions was reduced by laparoscopic adhesiolysis. Carnett’s test is an effective tool for evaluating pain and detecting its cause.

Electronic supplementary material

The online version of this article (10.1186/s13256-019-2026-7) contains supplementary material, which is available to authorized users.